- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04311697
Intravenous Aviptadil for Critical COVID-19 With Respiratory Failure (COVID-AIV)
ZYESAMI (Aviptadil) for the Treatment of Critical COVID-19 With Respiratory Failure
Study Overview
Status
Conditions
Detailed Description
Acute Lung Injury, which triggers Critical COVID-19 is a known lethal complication of Corona Virus (SARS-CoV-2) infection. Conventional medical therapy, including intensive care and respiratory support is associated with an 80% mortality. Aviptadil, a synthetic form of Human Vasoactive Intestinal Polypeptide (VIP) has been awarded FDA Orphan Drug Designation for the treatment of ARDS and admitted to the FDA CoronaVirus Technology Accelerator Program.
VIP binds to VPAC1 receptors on the pulmonary Alveolar Type II (ATII) cell. ATII cells comprise only 5% of lung epithelial cells but are critical for oxygen transfer, surfactant production, and maintenance of Alveolar Type 1 cells. 70% of VIP binds to this receptor. The Type II cell is also the cell selectively attacked by the SARS-CoV-2 virus via the ACE2 surface receptor.
Nonclinical studies demonstrate that VIP is highly concentrated in the lung and specifically bound to the ATII cell, where it prevents NMDA-induced caspase-3 activation in the lung, inhibits IL6 and TNFa production, protects against HCl-induced pulmonary edema, and upregulates surfactant production, These and other effects have been observed in numerous animal model systems of lung injury in mice, rats, guinea pigs, sheep, swine, and dogs. In these models, Aviptadil restores barrier function at the endothelial/alveolar interface and thereby protects the lung and other organs from failure.
Aviptadil ihas a demonstrated 20 year history of safety in phase 2 trials for Sarcoid, Pulmonary Fibrosis, Bronchospasm, and a phase I trial in ARDS. In that phase I trial, 8 patients with severe ARDS on mechanical ventilation were treated with ascending doses of VIP. Seven of the 8 patients were successfully extubated and were alive at the five day timepoint. Six left the hospital and one died of an unrelated cardiac event.
Five phase 2 trials of aviptadil have been conducted under European regulatory authority. Numerous healthy volunteer studies have shown that i.v. infusion of Aviptadil is well tolerated with few adverse effects including alterations in blood pressure, heart rate, or ECG. In addition to published studies of human use, Aviptadil has been used on a compounded basis in certain ICUs for many years in the belief that it preserves life and restores function in pulmonary hypertension, ARDS, and Acute Lung Injury (ALI).
In this study, patients who are hospitalized for Critical COVID-19 infection with respiratory failure will be randomly allocated to Aviptadil administered by intravenous infusion in addition to maximal intensive care vs. maximal intensive care alone. Primary endpoints will be improvement in blood oxygenation and mortality.
Study Type
Enrollment (Actual)
Phase
- Phase 2
- Phase 3
Expanded Access
Contacts and Locations
Study Locations
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California
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Fullerton, California, United States, 92835
- St. Jude Medical Center
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Irvine, California, United States, 92697
- University of California - Irvine
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Florida
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Miami, Florida, United States, 33176
- Baptist Hospital of Miami
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Miami, Florida, United States, 33136
- Miller School of Medicine / University of Miami Medical Center
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Kentucky
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Louisville, Kentucky, United States, 40202
- University of Louisville Hospital
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Missouri
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Saint Joseph, Missouri, United States, 64506
- Heartland/Mosaic Health
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Texas
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Abilene, Texas, United States, 79601
- Hendrick Health
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Fort Worth, Texas, United States, 76104
- Texas Health Harris Methodist Hospital
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Frisco, Texas, United States, 75033
- Texas Health Hospital Frisco
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Houston, Texas, United States, 77030
- Houston Methodist Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Critical COVID-19 with respiratory failure
- Physician determination that patient is on maximal conventional medical therapy
Exclusion Criteria:
- Pregnancy (pregnant women may apply for open label treatment under compassionate care IND
- Age <18 years
- Mechanical ventilation for more than 7 days in primary cohort. Mechanical ventilation>21 days in the exploratory cohort
- Mean Arterial Pressure < 65 mm Hg with use of pressor per ICU protocol
- Irreversible condition (other than COVID-19) with projected fatal course
- ECMO
- Current or recent (within 30 d) enrollment in another investigational trial of anti-IL6 drug;
- Active diagnosis of Acquired immune deficiency syndrome;
- Transplant patients currently immunosuppressed;
- Chemotherapy-induced neutropenia (granulocyte count <1000/mm3);
- Cardiogenic shock; congestive heart failure - NYHA Class 3 or 4;
- Recent myocardial infarction - within last 6 months and troponin > 0.5
- Anuria (urine output < 50 ml/d) or other signs of multi-organ failure
- Severe liver disease with portal hypertension;
- Recent stroke or head trauma within last 12 months
- Increased intracranial pressure, or other serious neurologic disorder;
- Liquid Diarrhea more than 3x/day; defined as more than 3 non-bloody watery stools within a 24-hour period, requiring additional fluid and electrolyte supplementation
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Aviptadil IV in escalating doses + standard of care
Patients will be administered Aviptadil IV in escalating doses of 50 pmol, 100 pmol, 150 pmol/kg/hr
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Aviptadil by intravenous infusion + standard of care (SOC).
SOC is defined not to include extracorporeal mechanical oxygenation.
Those requiring ECMO will be withdrawn from the study as treatment failures.
Other Names:
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Experimental: Placebo + standard of care
Patients will first be treated with placebo infusion + maximal intensive care
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Saline by intravenous infusion + standard of care (SOC).
SOC is defined not to include extracorporeal mechanical oxygenation.
Those requiring ECMO will be withdrawn from the study as treatment failures.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Resolution of Respiratory Failure (Alive and Free of Respiratory Failure)
Time Frame: Day 28
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Participant is Alive and Free of Respiratory Failure (without subsequent relapse over 7 days) determined as no longer requiring acute care or more than low flow oxygen
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Day 28
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants Alive at Day 60
Time Frame: Day 60
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Survival probability on logistic regression through day 60
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Day 60
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Number of Participants Achieving a Score of 6-8 on NIAID Ordinal Score Through Day 60
Time Frame: Day 60
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Achievement of score 6-8 on NIAID Ordinal Scale through day 60 The NIAID score is the patient's status on the following 8-point scale:1)Death2)Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO),3)Hospitalized, on non-invasive ventilation or high flow oxygen devices4)Hospitalized, requiring supplemental oxygen5)Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise)6)Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care7)Not hospitalized, limitation on activities and/or requiring home oxygen8)Not hospitalized, no limitations on activities-- a lower NIAID score is a worse outcome.
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Day 60
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Oxygenation Index as Measured by PaO2:FiO2 Ratio
Time Frame: Day 7
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oxygenation index (also known as Respiratory Distress Ratio) as measured by PaO2:FiO2 ratio (Respiratory Distress while on mechanical ventilation).
RDR: PaO2:FiO2 represents an intermediate clinical endpoint that is known to be predictive of survival.
RDR can only be measured in patients on mechanical ventilation because of its reliance on arterial blood gas measurements that are not routinely collected in non-intubated patients.
A higher score indicates a better clinical outcome.
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Day 7
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in IL-6
Time Frame: Day 28
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Change in IL-6, an inflammatory marker
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Day 28
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Study Chair: Jonathan C Javitt, MD, MPH, NeuroRx, Inc.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Coronaviridae Infections
- Nidovirales Infections
- RNA Virus Infections
- Virus Diseases
- Infections
- Respiratory Tract Infections
- Respiratory Tract Diseases
- Respiration Disorders
- Pneumonia, Viral
- Pneumonia
- Lung Diseases
- Wounds and Injuries
- Infant, Newborn, Diseases
- Infant, Premature, Diseases
- Thoracic Injuries
- COVID-19
- Coronavirus Infections
- Respiratory Insufficiency
- Respiratory Distress Syndrome
- Respiratory Distress Syndrome, Newborn
- Acute Lung Injury
- Lung Injury
- Physiological Effects of Drugs
- Adrenergic Antagonists
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Antihypertensive Agents
- Vasodilator Agents
- Gastrointestinal Agents
- Neuroprotective Agents
- Protective Agents
- Adrenergic alpha-Antagonists
- Vasoactive Intestinal Peptide
- Phentolamine
Other Study ID Numbers
- COVID-AIV
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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